Drug therapy of postprandial hyperglycaemia

It is widely accepted that the most challenging goal in the management of p atients with diabetes mellitus is to achieve blood glucose levels as close to normal as possible. In general, normalising postprandial blood glucose l evels is more difficult than normalising fasting hyperglycaemia. In additio n, some epidemiological studies suggest that postprandial hyperglycaemia (P PHG) or hyperinsulinaemia are independent risk factors for the development of macrovascular complications of diabetes mellitus. Recently, several drugs with differing pharmacodynamic profiles have been d eveloped which target PPHG. These include insulin lispro, amylin analogues, alpha-glucosidase inhibitors and meglitinide analogues. Insulin lispro has a more rapid onset of action and shorter duration of eff icacy compared with regular human insulin. In clinical trials, the use of i nsulin lispro was associated with improved control of PPHG and a reduced in cidence of hypoglycaemic episodes. Repaglinide, a meglitinide analogue, is a short-acting insulinotropic agent which, when given before meals, stimulates endogenous insulin secretions a nd lowers postprandial hyperglycaemic excursions. Both insulin lispro and repaglinide are associated with postprandial hyperi nsulinaemia. In contrast, amylin analogues reduce PPHG by slowing gastric e mptying and delivery of nutrients to the absorbing surface of the gut. alph a-Glucosidase inhibitors such as acarbose, miglitol and voglibose also redu ce PPHG primarily by interfering with the carbohydrate-digesting enzymes an d delaying glucose absorption. With the availability of agents which preferentially reduce postprandial bl ood glucose excursions, it is now possible to achieve glycaemic goals in a larger proportion of individuals with diabetes mellitus.